What’s Wrong With Me?
A medical mystery resolved. SYDNEY LONEY
THE PATIENT: Mackenzie Hild,
27, a medical student from Nevada City, Calif. THE SYMPTOMS: Excruciating stomach pain
THE DOCTOR: Dr. Christopher Skelly, chief of vascular surgery and endovascular therapy at the University of Chicago Medical Center
MACKENZIE HILD DREAMED of becoming a doctor, so she travelled to Uganda in 2009, after graduating from high school, to volunteer in a medical clinic. Within a week, the then 19-year-old began experiencing a sharp pain in her upper abdomen every time she ate or drank. She also felt nauseous. Hild attributed her symptoms to malaria pills and was relieved when the pain faded once she returned home and stopped taking them. But her symptoms didn’t disappear altogether. “I went off to study pre-med in college and still had occasional stomach aches,” Hild says.
The next summer, Hild returned to Africa, this time to Rwanda. Shortly after, the pain became so intense that she almost stopped eating. In three months, she lost 13 kilograms. “When I stepped off the plane, my mother freaked out,” she says.
When her symptoms didn’t improve, Hild’s GP referred her to a gastroenterologist. The doctor prescribed acid-reflux medication and recommended high-calorie meals to help her gain weight. But by then, eating had become intolerable. “As long as I didn’t eat or drink anything, I wasn’t in any pain,” says Hild.
She returned to college but began missing classes. At five-foot-three, Hild weighed only 35 kilograms. The school doctor sent her to the hospital, where she was placed in an anorexia
unit. Once eating disorders were ruled out, she was tested for parasites, HIV, Crohn’s disease—anything the doctors could think of. “They made me eat and gave me opioids afterwards,” Hild says. Finally, doctors inserted a feeding tube into her stomach. When that didn’t help, they bypassed her stomach with a tube that ran from her nose to her intestines. The pain disappeared.
Even with the tube, Hild needed to eat once a day to prevent her stomach from atrophying. “I’d choose a time, then curl up on my bed for the next three hours,” she says.
The tube caused sinus infections, rubbed her throat raw and made social situations awkward. A year later, doctors replaced it with one that entered into her abdomen.
Back at school, Hild wore a backpack that delivered liquid food to her intestines. In 2014, while working in South Africa, she was contacted by a medical student and patient advocate from California who had heard about her case and wanted to run it by more specialists.
Eventually it reached Dr. Christopher Skelly in Chicago, who suspected she had median arcuate ligament syndrome.
MALS develops when a ligament at the base of the diaphragm crosses the aorta and compresses the celiac artery, which carries blood to the stomach. “It’s a challenging disease because not much is known about it,” Skelly says. “Although it’s common, it’s not often diagnosed.”
The condition occurs in about 20 per cent of the population, but only one per cent experience pain. “We don’t know whether it’s caused by compression of the artery, compressed nerves or inflammation,” Skelly says.
Hild had been previously screened for MALS, but she was tested incorrectly and the results were negative. Skelly redid the tests and saw evidence of celiac compression on a CT scan. The only solution for most people is laparoscopic surgery. He told Hild, “If you want it done, I’ll do it.”
In February of 2015, Hild underwent the two-hour procedure. “The surgery doesn’t work for everyone,” Skelly says. “About 70 per cent of cases are successful, so we try to manage expectations—it can be devastating when it doesn’t work.”
When Hild woke from surgery, she ate scrambled eggs and cried with relief when she was pain-free.
At 27, Hild is now in her third year of medical school. She can swim and eat dark chocolate, the two things she missed the most. “I still have some issues, and my stomach is still really small, but I can handle a little discomfort compared to what it was,” she says. “Every morning I wake up and thank my lucky stars for Dr. Skelly.”